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*,SANTA <br />NAqffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www.sa nta -a na.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document mdy be lound at...http ://www. sa nta -a n a. o rqlp ba/ <br />(Please use a black or blue ink ball-point pen) <br />2 O lL W P Lca'Sso, Sc,n..\a- An< <br />Permit Number:tono6 tE4 <br />Property Owner:Li^).\ Lut <br />Contractor:SolaiT,uez License *: 1O { | +8 1 <br />State of Californaa requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />Aso,t, boxes below must be checked: <br />EI Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E[ Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <br />I hereby certify that I am the contractor or the property owner of the above proiect. lfurther certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />ma nufacturer's instructions. <br />lcheck onel Lice nsed Contractor tr Property Owner <br />NOIE: This self-certilicdtion is only used Ior projects that dflect the EXTERIOR of the strudure. This <br />process is opplicoble ONLY to projects where occess to the interior of the dwelling by o Sonto Ana <br />lnspedot is not required. <br />Dote:Signature:t/22/ >a>l <br />Have this completed form and the job-card readily available on final inspection! <br />Project Address: